Antimicrobial resistance is a major issue in global health. It is estimated that in the next 35 years about 3 hundred million people worldwide will die from resistance infections. Even though antimicrobial resistance is a complex issue, with many agents involved, such as environment, livestock, and agriculture, it is a medical problem. Many pathogens are involved but the main ones are the ESKAPE pathogens:

Enterococci.

Staphylococci.

Klebsiella.

Acinetobacter.

Pseudomonas.

Enterobacteriaceae.

The major threat comes from gram negative infections, with Pseudomonas and Enterobacteriaceae with the most lethal ones in terms of numbers, and Klebsiella and Acinetobacter being the most lethal ones in terms of resistance.

One of the main problems with antimicrobial resistance is that there is significant selection pressure due to antibiotic use in healthcare and agriculture, and that the mutations that cause bacterial resistance are very mobile. This is is fueled by poor hygiene, suboptimal dosing, lack of source control, and globalization (patients and tourist traveling from one country to another).

Also, there is significant variability in prevalence between countries and even between different regions in the same country, with local ecology being the main factor in terms of resistance.

The main concern with the rise of antimicrobial resistance is the significant impact on global health and economy that will follow if antibiotics stop being effective. As antibiotic resistance spreads, a vicious cycle begins in which broad spectrum empirical treatment is used due to resistant microorganisms. This will increase antibiotic resistance and as a consequence more inadequate empirical treatments will be used. Even though there are new antibiotics on the way, the problem is that none of them covers all the resistance patterns.

As regards surgical site infection, antibiotic resistance will make its prevention harder, causing a failure of empirical antibiotic therapy and limiting the use of antimicrobial guidelines.

Dr. Jan J. De Waele MD, PhD in the Department of Critical Care Medicine at Ghent University Hospital (Belgium) argues that an antibiotic stewardship program associated with the prevention of spread, proper use of antibiotics, hand hygiene, targeted screening and isolation are critical to control antibiotic resistance, and that surgeons must be involved in multidisciplinary teams monitoring antibiotic use and antibiotic resistance.